Hepatitis A

Hepatitis A virus (HAV) is a member of the family Picornaviridae. There are many types of viral hepatitis, each designated by a letter (A, B, C, etc).

Transmission

Primarily direct person-to-person transmission by the fecal-oral route (poor hand washing or anal contact). Transmission in food may be the result of an infected food handler inadequately hand washing or improperly handling foods; this especially applies to foods that are not cooked or that are handled after cooking. Consumption of improperly prepared food such as shellfish taken from contaminated waters (especially raw or undercooked mollusks) or inadequately washed produce may also serve as modes of transmission.

Symptoms

Hepatitis A is an acute viral illness characterized by the abrupt onset of fever, fatigue, jaundice (skin or eyes turning yellow/orange), loss of appetite, and nausea in older children and adults. Children younger than 6 years of age are usually asymptomatic or have a mild infection typically without jaundice. Persons at increased risk of spreading the disease include: food handlers, staff and attendees of child care centers or babysitting services, and persons providing direct patient care in hospitals, nursing homes, or institutions.

Prevention

Provide health education, reviewing transmission and communicability and emphasizing the importance of hand washing. Hepatitis A vaccineis currently required in Texas for all children entering school. There are also national recommendations for persons in high-risk groups including: persons with chronic liver disease or clotting factor disorders, men who have sex with men, injecting drug users, all susceptible persons traveling to countries where HAV is endemic and persons who work with primates.

School Exclusion Policy

Children with confirmed Hepatitis A should be kept out of school or childcare until one week after onset of illness. Rules for exclusion of sick children from school and childcare are outlined in the Texas Administrative Code, specifically Rule 97.7 for schools and Rule 746.3603 for childcare.

Recent Texas Trends

Hepatitis A case counts and incidence rates have declined rapidly and dramatically in Texas in response to vaccine availability and childhood immunization requirements. The steepest declines occurred in counties that have historically experienced the highest incidence rates and that implemented vaccine requirements soon after ACIP recommendations for targeted immunization. In 2014, 123 cases of hepatitis A were reported.